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APPLICATIO� FOR CONSTRUCT.ON PERMIT <br />CI7Y OF EVERETT • BUILDING DIVISION <br />3200 GEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOUTION fl COMBINATION fl BUILDING I-1 MECHANICAL �l PLUMBING �l SIGN <br />PROJECT ADDRESS <br />9/os - �j'rH <br />OWNER MAlI.A0DRE55 <br />� <br />1ENPNT <br />�E . E✓�irErT <br />cirr ziv <br />- �j'T� A-ut. S.E. C�rE2�-T' <br />CITV 21P <br />Z¢I �D-C CMt.IFON.Nti <br />ARCHItECT OR �ESIGNF.ii MAII ADORE55 CITV �I� �'�����t 7]S� �l L Z' <br />_p aL�µti,,V INc. �ill CA� 12nAb L�YJMOF�OS WA. i80to p,RAD51'!E OS`'iDiF <br />GEN[RALCONTRPCIOfi MAILAO�RE55 C11Y ZIP �— PNONE STAT[UCENSE� <br />MELHA�ACALCONTRACTJR MAILAODRESS GITV ZIP PIIONE STATEIIGENSE� <br />PLUM�I.NG CONTRACTOR MAIL A�ORE55 Clfv 21P PHONE SiATE LICENSE � <br />DESCRIBE WORK ANO SOl1ARE FOOT�6E INVOLVED <br />z�0 <br />LEGAL �ESCyR�IPTION O° PFOPERtt <br />l07 _['1_ _ BLOCN _ <br />^,..,.... _. #.L .i_ <br />PAflCELTA%I.D.NUMBBR <br />!0(037-ood' oo`b -onoo <br />CONS7RUCTION IOnN LENDER. ADJRESS. TELEPHOMS NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTE <br />SINK ISERVICE — BAR, <br />2r� [�t� <br />FEE <br />0 <br />0 <br />SUBTOTAL S <br />PERMIT 5 <br />� -- TOTAL FEE $ I <br />FOR OFFICE USE ONLY: <br />FRONT SFTP�/ REAR SFTUACK / SIOE SETBA� � <br />�� <br />l/SE20NE `/ W7AREA V�CANISIiF <br />IIYES fl NO <br />❑EIGHTLIMITPTION NOOFDWELLING 9ZEOPBID(S�TI <br />/) � � UNIIS _ <br />�� � v <br />I A1 ARM REO�D <br />i SPRINKI EP REO'0 <br />F Of f,ONST <br />„Y_ �/.G <br />LOnO B�SEMENT � � <br />A%�A fIYES i+'NO <br />HEATING SYSTEM: I 1 GAS rl ELECTRIC f l <br />CONTACT PERSON AND PIIONF. NO <br />I HEREBV CERTIFY THAT I HAVE REA� AND EXAMINED THIS <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING 7HIS TYPE OF <br />WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OH CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF. THE <br />PERF�JRMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAIION IS MADE AND I COMPLV WITH THE STATE <br />CONTRA/CTORS LAW 78.27 RCW AND 296200 WAC. <br />X�".Cr!!J�(�V'•� A/.�w.CJ— /0-�-'l' � <br />5GNATURE �� DATE <br />CITV BUSINE55 LICENSE NO. <br />MECHANICAL <br />TYPE OF EQUIPMENT <br />A/C — A/HNDLG UNITS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT (WOOC <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />Pl4H CIIECH NUMFIFR <br />i � <br />FEES <br />pUILOMG <br />PIUM�ING <br />MECHnNICAL <br />��D�110NN. PL�N CHF.CN <br />O1HEfi <br />CITY OF EVERETT <br />LOCALSALES <br />s TAX CODE IS 3105 <br />STAIE �I1IL�ING SURC11nRGE <br />rUPUC vlOnNS <br />TOTAL <br />SUB TOTAL 5 <br />PERMIT S <br />_ TOTAL FEE $ <br />Fer aECFirrNo. <br />���, /� <br />FEE <br />— <br />